LIVING WITH ADHD
Lots of kids misbehave in elementary school, but Benjamin Seebaugh’s bad conduct was rooted in a neurodevelopmental disorder. After numerous doctor's visits, screening tests and therapy sessions, Seebaugh was finally diagnosed with Attention Deficit Hyperactivity Disorder.
ADHD is a brain disorder that affects a person’s ability to focus, plan and organize. Diagnoses of the disorder is growing. Between 2003 and 2011, the percentage of U.S. children diagnosed with ADHD has risen from 7.8 percent to 11 percent, according to the Centers for Disease Control.
When he started taking medication, Seebaugh was transformed. "I could do what I was supposed to be doing my entire life," he said.
Seebaugh went on to become a student body vice president at WVU and is now set to graduate and pursue a graduate degree at Tufts University. Still, he dislikes the side effects and questions his dependence on the drug.
Seebaugh says some pharmacists act suspicious of Adderall users, but one pharmacy tech says there is good reason for the skepticism.
THE USERS, THE USES
It would be easy if we could place stimulant takers into neat categories like “users” and “abusers,” but the story is more complex than that. Our survey-takers said they took ADHD meds for routine studying, cramming for finals and even to lose weight.
Note: Respondents could choose more than one answer.
But when asked if this is unethical, 30 percent of our respondents said no, and around 40 percent were on the fence. These opinions reflect the culture of a campus known nationwide for partying.
A FOREIGN CONCEPT
Is Adderall the all-American drug?
Interviews with six students from five foreign countries reveal that they are far less familiar with study aids than U.S. students.
IT’S ALL AROUND US
On Twitter and Instagram, Adderall references are everywhere. It’s a powerful drug with serious side effects, but social media users tend to treat it as a laughing matter. This is a live feed of Twitter, the social networking service, showing the up-to-the-second flow of online chatter about “Adderall.”
And here is the buzz right now on Instagram, the photo- and video-centric social networking app. Tag your photo #adderall to add to this collection.
And it’s not just social media that references ADHD meds.
There are movies like the hit film “Limitless,” which features a drug with powerful brain-boosting capabilities. “How many of us ever know what it is to become the perfect version of ourselves?” the main character asks.
And books like Stephen Elliott’s 2009 memoir, “The Adderall Diaries.” The book chronicles a murder trial through Elliott’s stimulant-fueled eyes.
TV too. Adderall storylines are part of the drama on “Glee” and “Pretty Little Liars,” popular shows about high school students.
DIFFICULT DIAGNOSIS
University officials say it’s not always easy to tell who needs a prescription.
One in three students who take ADHD screening tests may be faking their symptoms.
That’s what psychologist Daniel Long found when he researched students visiting West Virginia University’s Student Health Services for attention deficit-related issues.
“It’s hard to tell if they’re putting forth full effort in the screening,” he said.
The abuse of ADHD drugs on college campuses, including WVU, is widespread. Some students believe it is easy to get a prescription from Student Health Services, but student health representatives say otherwise.
Part of the problem is that catching students pretending to have ADHD is a challenge. There is no laboratory test for ADHD.
"We have no way to tell whether it's being faked or not," said Dr. Brian P. Quigley, medical director of psychiatry for WELLWVU.
This puts the doctors at West Virginia University’s Student Health Services in a bind. The on-campus clinic in the medical center campus regularly receives students complaining about attention deficit issues, some legitimate, others not. An individual armed with knowledge of clinical attention deficit disorders may successfully fool doctors, Quigley acknowledges.
“There’s no definitive way to diagnose it,” Quigley said. “In my practice, I have been more mindful and prescribed less over time.”
Student says it’s not hard to get a prescription from WVU
When students seeking a diagnosis of ADHD arrive at Student Health Services, they participate in various lab tests and consulting sessions with psychiatrists and counselors. Quigley said behavior is frequently the cause of attention problems, not medical disorders. The truth often comes out during a student's initial meeting with a counselor.
"The counselor might say, 'This may not be ADHD. This may be substance related -- alcohol, cannabis,’" he said. "It could be related to sleep. All of us tend to cheat on our sleep when we're busy, that's just human nature."
If a student feels that medication is the only choice, WELLWVU does an internal evaluation, examining a student's psychiatric and developmental history before making a diagnosis. The ADHD screening process can be lengthy.
Students must participate in a clinical interview with a physician and take a computerized test that can take up to an hour and a half. Afterwards, students are advised about their condition and treatment options. If a student’s problems are determined to be legitimate, that student is interviewed about medical history, past school performance, and feedback from parents is obtained -- all before the student can get a prescription.
"When you come in and say, ‘I can't pay attention,’ you're not necessarily going to walk away with an Adderall prescription,” said Dr. Toni Goodykoontz, chief of Child and Adolescent Psychiatry in the WVU School of Medicine.
According to Long, the drugs used to be more commonly prescribed.
“Before..., we were told it was much easier to get (ADHD drugs) and there was an epidemic of people able to get it through our own psychiatric services,” he said. “I think that’s changed quite a bit now.”
One student who asked to remain anonymous said she sought help at the Carruth Center, the on-campus psychology clinic, for attention problems that had led to academic probation. After being advised that she may have ADHD, the student went to Student Health Services for testing.
“I wasn’t crazy about being tested, but they made me feel like I had no other choice,” she said.
At Student Health Services, she didn’t receive the response she expected.
“The doctor came in and immediately accused me of trying to abuse prescription medication. He refused to give me a prescription,” she said. “He told me I should remove caffeine from my diet and get on a regular sleep schedule.”
Two years later, the student continued to face attention problems. She returned to Student Health Services and was again denied a prescription.
Others still believe Student Health Services is not as rigorous as it should be. Michael Dunmire, a finance student at WVU and a technician at a local pharmacy, said students do not find it difficult to get ADHD prescriptions from WVU. He regularly fills prescriptions for Adderall and Vyvanse, many from Student Health Services.
“There’s no problem getting it prescribed compared to other drugs in their control class, like oxycodone and Percocet,” he said.
A local pharmacy technician says students don’t understand the medications’ side effects
Long, a staff psychologist at the Carruth Center, helped start the MindFit program, an alternative treatment program that helps students overcome psychological issues without medication.
“I got really motivated to help change people’s cultural awareness and understanding of what ADHD really is and how you treat it,” he said.
The MindFit program uses cognitive training, a series of mental exercises in a game-like format that helps students improve attention and working memory. The neurofeedback portion offers a process that teaches students to modulate brain wave activity to peak attention and focus.
These alternatives don’t appease all the students, however.
“I got the distinct impression that there was a percentage of individuals who didn’t seem as interested in the other recommendations we had… the non-pharmacological interventions,” he said. “They were most interested in seeing stimulant meds.”
Goodykoontz thinks too many students see the medication as a quick fix for their problems. In reality, the drugs can be unpredictable and habit-forming.
"I do think people tend to dismiss Adderall as a significant substance," Goodykoontz said. "People will say to me, ‘It's just Adderall,’ and they don't really understand the implications."
But why don’t students understand the dangers of a drug in the same schedule class as meth and cocaine? Lack of education may be partly to blame.
The “freshman seminar” is a class for incoming freshman designed to teach them time management skills, how to navigate campus resources, and how to stay safe in a college town. This course also includes a mandatory alcohol abuse awareness course. The class does not cover prescription drug abuse.
Cathy Yura, assistant vice president for student wellness, confirmed that focus groups on campus have identified study aid abuse as an issue on campus. But beyond directing individual students to Student Health Services and MindFit, the university has not made prescription drug abuse a priority in its student education programs.
Nevertheless, ADHD medication abuse is a growing issue on college campuses, according to Goodykoontz.
"Adderall is one of the most abused substances on college campuses," she said. "It's not just here at WVU - when we talk to colleagues from around the country, they have the same problem."
Student with ADHD says his diagnosis was rigorous, but that may not always be the case
Pharmacies try to identify fraudulent prescriptions, but their power is limited, said Dunmire, the pharmacy tech.
“We do everything we can to stop (patients from abusing prescriptions),” Dunmire said. “But there’s so much out of our control. What other doctors are they going to? What other pharmacies?”
A patient can visit two separate doctors in two different states, get two prescriptions for Adderall and fill them at both different pharmacies.
“That’s where our struggle comes from,” Dunmire said. “There’s no (national) central database for patient information.”
A database exists between pharmacies in West Virginia: the Controlled Substance Automated Prescription Program, but this only links pharmacies within the state. Dunmire also said the system can take up to a month to update internal information.
“At that point, it’s kind of pointless,” he said. “There’s so many parties involved, it’s hard to tell who is actually causing this problem.
“I don’t think anybody really knows.”
ABOUT THIS PROJECT
How do college students achieve exceptional grades? Is it worth it to bear down, hit the books and skip the parties? Or will you just lose to students juicing their academic performance -- taking top-shelf drugs to get that top-shelf score?
A team of eight students from West Virginia University’s journalism, computing and art programs investigated those questions and more for an entire semester under the leadership of Sarah Slobin, a senior graphics editor at the Wall Street Journal. One of our goals was to create an indepth work of journalism that is designed, first and foremost, to be consumed on your smartphone.
We wanted to know why it appears that Adderall and other mental stimulants have surged in popularity on college campuses. Our team dove into social media and hit the campus to understand this culture. We created and distributed a survey around campus that polled students on their study habits and their attitudes toward stimulant drugs such as Adderall.
The anonymous survey was conducted online over the course of seven days, between February 11th and 17th. There were 208 respondents. We recruited survey participants through social media, word of mouth and fliers distributed on campus, and results were collected in a manner that participants cannot be identified. This survey's results became the guiding force of our reporting, helping us develop sources and illuminating the issues we needed to cover.
Inside this project are testimonials from users and abusers and a collection of some of the most telling social media. The team talked to ADHD experts on campus, pored over academic studies and asked WVU administrators what the university is doing about study aids.
Our main discovery? The drugs are everywhere, from dorm rooms to Instagram. Even students who don’t touch the drugs are very familiar with them. ADHD drugs, whether taken by prescription or not, have truly become the drug next door.
CREDITS:
Students:
Brittany Furbee, P.I. Reed School of Journalism
Bryan Bumgardner, P.I. Reed School of Journalism
Kristen Basham, P.I. Reed School of Journalism
Lauren Schiefelbein, College of Creative Arts
Rachel Yoke, P.I. Reed School of Journalism
Timothy Saar, P.I. Reed School of Journalism
Tonye Iyalla, Statler College of Engineering and Mineral Resources
Whitney Godwin, P.I. Reed School of Journalism
Project leaders:
Sarah Slobin, senior graphics editor, The Wall Street Journal
Elaine McMillion, documentary filmmaker and creator of Hollow
Dana Coester, assistant professor, P.I. Reed School of Journalism
John Temple, associate professor, P.I. Reed School of Journalism
Professional consultants:
Andrew Garcia Phillips, owner, Chartball.com
Brad Stalnaker, graphic designer, West Virginia University
Team mentors:
Rob Barry, investigative reporter, Wall Street Journal
Brian Boyer, news applications editor, NPR
Matthew Craig, photographer, co-founder and CEO, Blink
Gabriel Dance, interactive editor, The Guardian
Greg Pliska, film/TV/theater composer and musical director, War Horse
Zach Seward, senior editor, QZ
Megan Thee, editor for news surveys, The New York Times